Thursday, August 16, 2018

“Don’t Be Stupid, Be a Smarty”: Why Anti-Authoritarian Doctors Are So Rare by BRUCE E. LEVINE

“Don’t be stupid, be a smarty, come and join the Nazi Party” is an intentionally obnoxious line from the hilarious “Springtime for Hitler” in Mel Brook’s The Producers. Not hilarious is the reality that doctors in Nazi Germany were “smarties” in Brook’s sardonic sense, as they joined the Nazi SS in a far higher proportion than the German general population. Also not funny is that U.S. doctors and healthcare professionals—from their “aiding torture” (description used in the CIA Inspector General’s Report) at Guantánamo Bay, Abu Ghraib, and elsewhere to the more recent drugging of detained child migrants—have served U.S. authoritarian policies.

In the Journal of Medical Ethics in 2012, Alessandra Colaianni reports “More than 7% of all German physicians became members of the Nazi SS during World War II, compared with less than 1% of the general population. . . . By 1945, half of all German physicians had joined the Nazi party, 6% before Adolf Hitler gained power.” Colaianni points out, “Physicians joined the Nazi party and the killing operations not at gunpoint, not by force, but of their own volition.”

Colaianni offers several explanations for doctors’ penchant for authoritarianism—reasons that continue to exist today. Two of her explanations are doctors’ socialization to hierarchy and their exceptional career ambitiousness. “Medical culture is,” she concludes “in many ways, a rigid hierarchy. . . . Those at the lower end of the hierarchy are used to doing what their superiors ask of them, often without understanding exactly why. . . . Questioning superiors is often uncomfortable, for fear both of negative consequences (retaliation, losing the superior’s respect) and of being wrong.” She also points out, “Becoming a doctor requires no small amount of ambition. . . .The stereotypical pre-medical student [is] ruthlessly competitive, willing to do anything to get ahead.”

“Authoritarian”is defined by the American Heritage Dictionary as “characterized by or favoring absolute obedience to authority.” Authoritarians in power demand unquestioning obedience from those with lower rank, and authoritarian subordinates comply with all demands of authorities.

I have a special interest in authoritarianism among psychiatrists and psychologists. In their schooling and training (and often beyond that), they live for many years in a world where one complies with the demands of all authorities, and so their patients who challenge authority and resist illegitimate authority appear to be “abnormal” and “mentally ill.”

In my training to become a psychologist, I discovered that students, trainees, and subordinate mental health professionals who challenged authorities routinely got labeled as having “authority issues,” which stigmatizes them in terms of career advancement. Both the selection and socialization of mental health professionals breed out most anti-authoritarians, and the handful of anti-authoritarians who manage to slither through the academic hoops to obtain their degrees have all, from my experience, paid a career price for challenging illegitimate authority. And that punishment has intimidated other mental health professionals from taking an anti-authoritarian path.

Perhaps the most famous anti-authoritarian psychiatrist in U.S. history is Thomas Szasz. His The Myth of Mental Illness(1961) brought the wrath of the entire psychiatric establishment against him. Szasz continues today to be widely misunderstood. “He did not deny that people suffer mentally and emotionally,” Leifer pointed out, “He was not even denying mental illnesses exist. He acknowledged that they exist, but . . . not as diseases in the same sense that diabetes or pneumonia are diseases.” Szasz argued that “mental illness” is a metaphor for emotional and behavioral problems in living. Szasz has been widely accused of being anti-psychiatry, but what he opposed was coercive psychiatry. Szasz was a fierce opponent of involuntary psychiatric treatment, believing psychiatry and psychotherapy should only be utilized when there is informed choice and consent.

What was establishment psychiatry’s reaction to Szasz? Psychologist Chuck Ruby reports, “Starting immediately on his open revolt, Szasz’s colleagues ridiculed him, and they considered him a traitor to the profession of psychiatry.” Ruby, the Executive Director of the International Society for Ethical Psychology and Psychiatry, notes, “There were unsuccessful attempts by New York state officials to remove him as a professor at SUNY Upstate Medical University at Syracuse, and his superiors at the university attempted to goad him into quitting.” Szasz was a full professor with tenure; but the chairman of the Department of Psychiatry, David Robinson, according to Leifer, “tried to drive Szasz into insubordination so he could fire him.” Szasz ultimately had to hire a lawyer to defend and protect his tenured appointment.

Ron Leifer, lacking tenure, was far more vulnerable to a career “hit.” Leifer reported that he was “excommunicated” from academic psychiatry in 1966, “fired [by Robinson] in retaliation for publishing a book that was interpreted to be criticism of psychiatry.” Leifer recounted, “I applied at other departments of psychiatry . . . but was rejected because of my association with Szasz. So much for the free expression of ideas in academic psychiatry!”

Then there is the case of Loren Mosher (1933–2004), the psychiatrist perhaps most respected by ex-patients who have become activists fighting for human rights. In 1968, Mosher became the National Institute of Mental Health’s Chief of the Center for Schizophrenia Research. In 1971, he launched an alternative approach for peoplediagnosed with schizophrenia, opening the first Soteria House in Santa Clara, California. Soteria House was an egalitarian and non-coercive psychosocial milieu employing nonprofessional caregivers. The results showed that people do far better with the Soteria approach than with standard psychiatric treatment, and that people can in fact recover with little or no use of antipsychotic drugs. Mosher’s success embarrassed establishment psychiatry and displeased the pharmaceutical industry. Not surprisingly, the National Institute of Mental Health choked off Soteria House funding, and Mosher was fired from NIMH in 1980.

Dissident psychiatrists are a rare breed, and those whom I have known tell me that the attempted hit on Szasz and the successful hits on Leifer and Mosher were as predictable as any hit by La Cosa Nostra (“our thing”)—as the psychiatry establishment is also not exactly tolerant of any challenges to “their thing.”

Anti-authoritarian patients should be especially concerned with psychiatrists and psychologists—even more so than with other doctors. While an authoritarian cardiothoracic surgeon may be an abusive jerk for a nursing staff, that surgeon can still effectively perform a necessary artery bypass for an anti-authoritarian patient. However, authoritarian psychiatrists and psychologists will always do damage to their anti-authoritarian patients.

Psychiatrists and psychologists are often unaware of the magnitude of their obedience, and so the anti-authoritarianism of their patients can create enormous anxiety and even shame for them with regard to their own excessive compliance. This anxiety and shame can fuel their psycho-pathologizing of any noncompliance that creates significant tension. Such tension includes an anti-authoritarian patient’s incensed reaction to illegitimate authority.

Anti-authoritarian helpers—far more commonly found in peer support—understand angry reactions to illegitimate authority, empathize with the pain fueling those reactions, and genuinely care about that pain. Having one’s behavior understood and pain cared about opens one up to dialogue as to how best to deal with one’s pain. Because anti-authoritarian mental health professionals are rare, angry anti-authoritarian patients will likely be “treated” by an authority who creates even more pain, which results in more self-destructiveness and violence.

It is certainly no accident that anti-authoritarian psychiatrists and psychologists are rare. Mainstream psychiatry and psychology meet the needs of the ruling power structure by pathologizing anger and depoliticizing malaise so as to maintain the status quo. In contrast, anti-authoritarians model and validate resisting illegitimate authority, and so anti-authoritarian professionals—be they teachers, clergy, psychiatrists, or psychologists—are not viewed kindly by the ruling power structure.

About Me

Grew up in a rural area, farming and logging and construction filled my life with many skills. Yet my heart as always followed a simpler life. It has been for the love of nature and all it entails that has led me to happier place full of adventures, great and small, trying never to miss the opportunity to help each and everyone.